Create a new oath for behavioral healthcare organizations

Recently, physicians around the world got a nice Halloween treat from the World Medical Association in its update of the Declaration of Geneva. Unfortunately, we have been getting too many tricks as medicine more and more has become a for-profit business. Ever since for-profit managed care emerged in the late 1980s, behavioral healthcare has been a particular target for cost savings.

As a result, physicians, including psychiatrists, have been burning out at epidemic rates. We now have the highest burnout rate of any profession in the United States. Though there is less data on other health and mental healthcare professional disciplines, such as psychologists, social workers and nurses, it seems that their burnout rate is also worrisome.

The main problem is that for-profit systems tend to disempower clinicians so that we can’t use our healing skills in the way we know how. Our scheduled time with patients is often too short.

My heart broke a few years back when a few patients complained that I wasn’t spending enough time with them. They were right, and I knew it, but I couldn’t make it better unless I left that system, which I eventually did. Even that limited time was intruded upon by the new electronic medical records.

Doing our best

So, how does the World Medical Association’s ethical update help? It relates to this clause:

“I will attend to my own health, well-being, and abilities in order to provide care of the highest standard.”

Sounds good, doesn’t it? And certainly we have some ability to attend to our own health and well-being, as indeed we have been doing more over the last decade. However, we are finding out that the results are at best limited and at worst, it is like blaming the victims of a bad system.

If we continue to burnout, our patients suffer worse quality of care. When we are burning out, we are exhausted, relate less well, and are prone to more mistakes. Hence, we can’t often fulfill that clause of providing care of the highest standard.

That actually reflects back to the time when the Hippocratic Oath was said to develop. There is this clause at the end: “But I will keep pure and holy both my life and my work.”

We psychiatrists are doing what we can. I am a member of an emerging workgroup on psychiatrist wellness and burnout, created by the American Psychiatric Association. Stay tuned for more on this important initiative.

Nevertheless, the really nourishing treat would be for governments and businesses to adopt an ethical principle complementary to the Hippocratic Oath, a kind of “Systematic Oath.” It should have this clause: “Every healthcare organization will support the health, well-being and abilities of their clinicians and staff order to provide the highest quality of care possible with the resources at hand.” Would your organization take such an oath?